Ask an expert: Heavy kids

Q: “My 11-year-old son is very active and eats healthy foods, but is still heavy. Will he grow out of the fat, or is there something we can or should do now? Kids tease him, and he’s very sensitive about being heavier than his friends.”

Answer provided by Connie Warner, MS, RD, pediatric dietitian, Providence Neurodevelopmental Center for Children:

I’m really glad that you asked about your son. While the teasing surely bothers him, there are much bigger health risks at stake for overweight children. Among the kids I meet before they begin Providence’s Healthy ’n Fit Pediatric Weight Management Program, many have pre-diabetes and elevated cholesterol. I’ve seen 10 year olds whose lab results look like they came from 50 year olds — and I’m not talking about healthy 50 year olds.
 
In my experience, these kids don’t just grow out of it anymore unless they have a little help. Twenty years ago they might have, but times have changed. In the last couple of decades, there’s been an explosion in fatty convenience foods and sodas marketed to kids, as well as electronic toys and video games that encourage kids to sit still instead of playing outside and burning off calories. The result: In 1980, only about one in 20 kids was overweight, but today, it’s more like one in three.

To beat those odds, kids and families need new strategies for eating and activity. Now is the time to question the way your family has done things in the past, and to start building new, healthy habits for the whole family. Here are some things to think about.

How heavy is heavy?

I would never encourage a mother to weigh her children every day. But I do encourage parents to review their children’s growth charts every year.

Every child who sees a pediatrician is weighed and measured at every appointment. These numbers are used to determine the child’s body mass index (BMI), a measure of weight relative to height that’s used from age 2 on. Ask your pediatrician to print out a chart that shows how your son’s BMI compares to other 11-year-old boys. A BMI that enters the 85th percentile (that is, within the heaviest 15 percent of boys the same age) is considered overweight. When a child hits that point, it’s time to ask a pediatrician and/or a dietitian for a consultation about weight management. A BMI above the 95th percentile is considered obese, and is a serious health concern.

What can, or should, you do?

Assuming that your son’s BMI falls within the overweight or obese range, what should you do? First, what not to do: Don’t put your son on a diet. “Dieting” is a bad idea for kids, whose bodies and brains are still growing and developing. Instead, work on changing behaviors and developing healthy strategies. Rather than trying to lose weight, for example, your son might set a goal to maintain his current weight, without gaining, until he’s grown tall enough to put him back in a healthy BMI range. That may sound easy, like simply “growing into the weight,” but it can be a hard thing to do, especially if he is close to the 95th percentile. There are reasons why he got to that point, and to stop the weight gain from continuing, some things are going to have to change. In my work with kids and their families, the top four issues that we focus on are:
  • What you eat 
  • Where you eat
  • How much you eat
  • Exercise
Notice that I am saying “you” instead of “your son.” I often hear parents tell their kids, OK, now you need to do this. But it’s not just your son who needs to make changes — you need to set an example of the good behaviors you are trying to encourage, and the new rules need to apply equally to everyone in the family. The good news is that it won’t just be your son who benefits — you all will.

What you eat — focus on fruits and vegetables

The best advice I can offer about eating is to increase the amount of fruits and vegetables in your family’s meals. If you focus on this, then just about all the other eating advice falls into place. Fruits and vegetables are low in calories and high in nutrition and fiber. They’re also filling — the more you eat, the less room there is for higher-calorie foods.

Parents often ask me, how do you get kids who don’t like vegetables to start? One way is to grow a garden together — kids who normally won’t touch vegetables often will eat them straight out of the garden, especially if they’ve helped grow the garden themselves. Take your son to the farmers market and let him pick out something interesting. At the grocery store, show him how to select vegetables and put him in charge of bagging them. Cut up colorful vegetable sticks and serve them with a healthy bean- or yogurt-based dip as your appetizer before dinner. Explore recipe ideas together on www.fruitsandveggiesmorematters.org and let him help make preparations that he likes. For more ideas, read my article, "12 ways to turn your kids into vegetable lovers." Now is the time to start making fruits and vegetables a part of your son’s life — for life.
 
My second piece of eating advice is actually about drinks: Limit them to milk and water. Soda pop, sports drinks, coffee-shop drinks, juice boxes — they’re all high in calories, and kids shouldn’t be drinking their calories (neither should adults, for that matter). Even 100 percent fruit juice isn’t recommended anymore — whole fruit is better.

Convenience foods are another big problem, delivering high amounts of fat, salt and sugar, not to mention preservatives. Instead of buying “convenience” foods, buy healthy ingredients and make good food that’s convenient:
  • Instead of buying “lean” hot pockets, fill the fridge with lean turkey, tuna, fresh cucumbers, lettuce, and whole-grain bread so anyone can throw together half a sandwich in a cinch.
  • Keep whole-wheat English muffins, low-fat cheese and prepared tomato sauce on hand for mini pizzas in minutes. 
  • Stock up on nuts, dried fruits and whole-grain cereals and let your son mix up his own trail mix — then package it in single-serving (half-cup) bags. 
  • Buy low-fat yogurt and fresh fruit to make quick, colorful parfaits.

These are all fun, low-calorie, tasty snacks, and they’re every bit as convenient as those unhealthy “convenience foods.”

Where you eat — set some limits

Set a new family rule: We eat food at the kitchen table only. Not the bedroom, not the computer room, not the TV room. We all know how easy it is to down a whole bag of chips in front of the TV without even thinking about it. Eating in front of the TV or computer also sets up a pattern: “When I watch TV or play computer games, I need to eat something.”

Break the pattern. Focus on what is being eaten by enjoying it at the kitchen table, without distractions.

How much you eat — serve smaller portions

Portion sizes are one of the main issues I work on with kids 12 and under. Several studies have shown that, no matter how large the portion you serve, most people will eat the full amount. When smaller portions are served, people usually eat less, even if they are given the option to go back for more. So serve smaller portions. An easy way to do that is to start using smaller plates and bowls. Another way is to dish up the amount you would normally serve to each person, and then put half of everything back (don’t point out that you’re doing this — just start doing it). Most kids who like to eat usually ask for seconds. If your son asks, go ahead and give him the other half, or part of it — he still will have eaten less overall than he used to.

Exercise — shut down the computers and TV sets

You say that your son is active, but how active? Kids need an hour of active play every day, and that doesn't mean Nintendo. They need to limit screen time and get up, get out, walk to the park, shoot hoops, jump, hop, skip — anything to get moving.


Find ways to increase activity for the whole family. Take walks before or after dinner each night. Give fewer video games as gifts and give more jump ropes, hula hoops, and lawn games like badminton and croquet. Teach the neighborhood kids how to play kick the can. When the weather is bad, encourage your son to sign up for an indoor sport, take him swimming at an indoor public pool, or get him a mini trampoline he can jump on while he listens to music.

What you have to gain — and lose

The suggestions I’ve offered you are some of the same suggestions I make to kids and parents who enroll in our pediatric weight management program. When I follow up with them 10 weeks later, after they’ve completed the program, I’m always amazed at the improvements they’ve achieved in such a short time:
  • I’ve seen boys your son’s age lower their cholesterol by nearly 100 points.
  • One boy reduced his triglyceride levels by an astounding 303 points.
  • Blood sugar levels often improve dramatically. 
  • Weight gain slows or stops, many children lose a few pounds, and parents are often excited to find that they’ve lost weight, too.
By and large, the families I work with are thrilled to learn that there are ways to make changes that aren’t overwhelming or all that hard. If you try some of these changes, you and your son may soon be feeling the same way. Good luck!

Updated March 2014

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Resources to help children and families:
Healthy ’n Fit Pediatric Weight Management Program  
Individual nutrition counseling

For more information:
Healthy Eating for Children